Ind. scrambles to address ruling on mentally ill inmates

Jan. 2, 2013
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Ken Falk, left, legal director of the ACLU of Indiana, says at least 11 mentally ill inmates isolated in Indiana prisons have committed suicide, one of the reasons a federal judge ruled Monday that the state has violated prisoners' Eighth Amendment protections from cruel and unusual punishment. / Charlie Nye, The Indianapolis Star

by Tim Evans, USA TODAY

by Tim Evans, USA TODAY

INDIANAPOLIS -- Weeks after a doctor at an Indiana prison determined a suicidal prisoner was experiencing "severe difficulty coping with segregation," the Indiana Department of Corrections placed the inmate back in a segregation unit.

Isolated for 23 hours a day in a cell not much larger than a closet at New Castle Correctional Facility, the inmate's mental state continued to deteriorate.

Two weeks later, he was dead -- one of at least 11 mentally ill inmates who committed suicide while in IDOC segregation units from 2007 through July 2011.

Now state officials and advocates are scrambling for solutions in the wake of a federal court ruling that found Indiana's treatment of mentally ill prisoners in segregation units violates the Eighth Amendment's prohibition of cruel and unusual punishment.

The decision was issued Monday by Judge Tanya Walton Pratt in the U.S. District Court for the Southern District of Indiana in a suit filed by the American Civil Liberties Union of Indiana on behalf of Indiana Protection and Advocacy Services Commission and a group of inmates.

Pratt found "mentally ill prisoners within the IDOC segregation units are not receiving adequate mental health care in terms of scope, intensity, and duration."

The judge also noted IDOC was aware of concerns about its treatment of mentally ill prisoners and "has been deliberately indifferent."

Ken Falk, the ACLU of Indiana's legal director, hailed the ruling as a win not only for mentally ill inmates, but for all Indiana residents.

The majority of inmates with mental illness, Falk explained, will eventually be released and it is better for everyone if their problems are addressed before they re-enter society. Treatment also can help reduce recidivism, saving tax dollars.

The judge's order does not prescribe specific changes needed at IDOC. Instead, Pratt said further court proceedings will be conducted "as to the relief to which the plaintiffs are entitled." In general, the order says, that means at least basic mental health care.

It was unclear Tuesday whether IDOC will appeal the ruling -- or what, if anything, officials plan to do to improve the treatment of mentally ill inmates.

Douglas Garrison, an IDOC spokesman, said officials already have taken numerous steps to improve the care and treatment of offenders.

He said IDOC has implemented a 30-day review of segregation status for mentally ill offenders and is removing offenders from segregation if their condition deteriorates. IDOC also has increased use of step-down transition units in segregation "to allow offenders the ability to 'earn' their way out of segregation," he said. And inmates have more access to group mental health counseling sessions.

Indiana is not alone in facing the growing challenge of dealing with mentally ill inmates, said Robert L. Trestman, a professor of Medicine, Psychiatry and Nursing at the University of Connecticut and executive director of Correctional Managed Health Care, which provides medical and mental health care to inmates in Connecticut prisons.

"This is a national issue," Trestman explained, "that has come about because of two different trends that have collided."

He cited a dramatic increase in the number of inmates with severe mental illness in the past 20 years and the growing use of prisoner segregation -- a sort of "prison within a prison" -- to manage prison populations.

"Each one is a problem in its own right," he said, "but when they overlap you have a profound problem."

Trestman said segregation was initially intended to punish inmates who committed violent crimes while in prison, and to protect other prisoners and staff. But in many instances, the bar has been lowered to include inmates who are uncooperative or violate rules, filling segregation units with mentally ill prisoners whose conditions often deteriorate with isolation.

Mental health care shortcomings in Indiana prisons are a reflection of a broader lack of commitment to provide adequate services to people with mental illness, said Stephen C. McCaffrey, CEO of Mental Health America of Indiana.

"This is a big concern," he said. "Do we need more services in DOC? Yes. Do we need more services in the community? Yes."

Still, the IDOC's treatment of prisoners with mental illness "has improved greatly over time," McCaffrey said. "But that is not to say there are not issues, as is true with our entire mental health system."

Judge Pratt found significant shortcomings in IDOC's care of prisoners with mental illnesses, noting many placed in segregation units show significant signs of "decompensation," an exacerbation of their symptoms and illness with sometimes fatal consequences.

"Nearly 50 percent of inmate suicides occurring within the Department of Correction since 2007 were committed by mentally ill offenders in a segregated setting," Pratt wrote in her ruling. "The Court also found that the harmful effects of segregation on mentally ill offenders were known to the Department of Correction."

That was the situation with the New Castle inmate who committed suicide after he was returned to segregation shortly after the doctor found that isolation was making his mental state worse. The case was one of several accounts cited in court documents about inmates who committed suicide or experienced significant, adverse effects from being isolated without proper evaluation or care.

Falk of the ACLU said the ruling isn't about coddling prisoners or providing them with a Cadillac treatment plan.

"We are talking about 'minimally adequate' treatment," he said.

Falk admitted that IDOC has been dealt a difficult hand, with a huge influx of inmates with mental illness.

Still, Falk and advocates said, IDOC must step up to find solutions and make changes in a policy that has resulted in hundreds of men and women with mental illness being required to spend as much as 23 hours a day in their cells, with limited evaluation and treatment.

Advocates pointed to several other states -- including California, Mississippi, Ohio and New York -- as possible models. Most involve better evaluations and added treatment, individually and in group settings, along with fewer hours of isolation.